CONTINUITY OF CARE & OUTCOME OF SEVERE MENTAL DISORDERS

提出了一个为期五年的研究和教育计划，以准备主要研究者在精神卫生服务研究的职业生涯，重点是严重精神障碍患者。候选人的长期研究目标是在这些患者群体的服务研究中应用严格的流行病学方法和分析工具，并调查他们的护理最佳方法，特别是在疾病的早期阶段。这些知识对于为这一群体规划医疗服务至关重要。该计划有两个主要组成部分：教育计划和研究项目。教育计划包括流行病学、生物统计学和心理健康服务研究方面的课程。此外，一批在精神病学流行病学、精神卫生服务研究、早期干预和精神分裂症研究方面经验丰富的专家将提供辅导、监督和咨询。研究和教育计划将在哥伦比亚大学精神病学系与其他一些机构的研究人员合作进行。本研究旨在探讨连续性照护对首次入院精神分裂症及情感性精神病患者病程及预后的影响。近年来，早期治疗生涯对精神病患者后续病程和预后的影响已引起广泛关注。该项目的重点是护理的连续性，这是早期治疗生涯的一个基本要素。护理的连续性在这里被定义为服务系统在一个无缝的整体中将治疗片段联系起来的程度。将在两个样本中检查护理连续性对患者短期和中期病程和结局的影响：a）萨福克县精神健康项目（SCMHP），一项对纽约萨福克县首次入院精神病患者的流行病学纵向研究，和B）国家早期精神病和自杀合作研究（NCSEPS），一项对首次入院的精神分裂症和情感性精神病患者的大规模研究，这些患者在美国军人中通过退伍军人事务部进行随访。该项目有四个具体目标，前三个目标与SCMHP样本有关，第四个目标与NCSEPS有关。具体目的是：1）描述精神分裂症和情感性精神病患者的治疗生涯; 2）研究疾病早期的连续性护理对24个月和48个月结局的影响; 3）确定连续性护理对不同诊断组结局的影响是否相似;和4）在NCSEPS样本中，检查首次在军事医院住院并被诊断为精神分裂症或情感性精神病并被转介到VA系统继续治疗的男女军人护理不连续的影响。出院后的治疗。

A five-year research and educational program is proposed to prepare the principal investigator a career in mental health services research with a focus on patients with severe mental disorders. The candidate's long-term research goal is to apply the rigorous methods and analytic tools of epidemiology in services research for these patient groups and to investigate the optimal approaches to their care, especially in the early phases of the illness. Such knowledge will be essential for planning empirically-based services for this population. The program has two major components: an educational plan and a research project. The educational plan involves course work in epidemiology, biostatistics and mental health services research. In addition a group of highly experienced experts in psychiatric epidemiology, mental health services research, early intervention and schizophrenia research will provide tutorials, supervision and consultation. The research and educational programs will be pursued at the Department of Psychiatry, Columbia University, in collaboration with researchers in a number of other institutions. The research project aims to investigate the impact of continuity of care on the course and outcome of the first admission patients with schizophrenia and affective psychoses. The impact of early treatment career on the subsequent course and outcome of psychotic of psychotic disorders has attracted much attention in recent years. This project focuses continuity of care which is an essential element of the early treatment career. Continuity of care is defined here as the degree to which the service system links episodes of treatment in a seamless whole. The impact of continuity of care on the short- and medium term course and outcome of patients in two samples will be examined: a) the Suffolk County Mental Health Project (SCMHP), an epidemiological longitudinal study of first admission psychotic patients in Suffolk County, New York, and b) the National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a large- scale study of first admission patients with schizophrenia and affective psychoses among US military personnel with follow-up through VA services. The project has four specific aims, the first three pertain to the SCMHP sample and the fourth to the NCSEPS. The specific aims are, 1) to describe the treatment career of patients with schizophrenia and affective psychoses; 2) to study the impact of continuity of care in the early course of illness on the 24- and 48-month outcomes; 3) To determine whether the impact of continuity of care on outcomes is similar for different diagnostic groups; and 4) in the NCSEPS sample, toe examine the impact of discontinuity in the care of servicemen and -women who are admitted for the first time in the military hospitals with a diagnosis of schizophrenia or affective psychosis and are referred to the VA system for continuation of treatment after discharge.